DOCSLIB.ORG

ACG Clinical Guideline: Management of Irritable Bowel Syndrome

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
ACG Clinical Guideline: Management of Irritable Bowel Syndrome CLINICAL GUIDELINES 17 ACG Clinical Guideline: Management of Irritable Bowel Syndrome Brian E. Lacy, PhD, MD, FACG1, Mark Pimentel, MD, FACG2, Darren M. Brenner, MD, FACG3, William D. Chey, MD, FACG4, 5 6 7 02/05/2021 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= by http://journals.lww.com/ajg from Downloaded Laurie A. Keefer, PhD , Millie D. Long, MDMPH, FACG (GRADE Methodologist) and Baha Moshiree, MD, MSc, FACG Downloaded Irritable bowel syndrome (IBS) is a highly prevalent, chronic disorder that significantly reduces patients’ quality of life. Advances in diagnostic testing and in therapeutic options for patients with IBS led to the development of this first-ever from http://journals.lww.com/ajg American College of Gastroenterology clinical guideline for the management of IBS using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Twenty-five clinically important questions were assessed after a comprehensive literature search; 9 questions focused on diagnostic testing; 16 questions focused on therapeutic options. Consensus was obtained using a modified Delphi approach, and based on GRADE methodology, we endorse the by following: We suggest that a positive diagnostic strategy as compared to a diagnostic strategy of exclusion be used to improve BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= time to initiating appropriate therapy. We suggest that serologic testing be performed to rule out celiac disease in patients with IBS and diarrhea symptoms. We suggest that fecal calprotectin be checked in patients with suspected IBS and diarrhea symptoms to rule out inflammatory bowel disease. We recommend a limited trial of a low fermentable oligosaccharides, disacchardies, monosaccharides, polyols (FODMAP) diet in patients with IBS to improve global symptoms. We recommend the use of chloride channel activators and guanylate cyclase activators to treat global IBS with constipation symptoms. We recommend the use of rifaximin to treat global IBS with diarrhea symptoms. We suggest that gut-directed psychotherapy be used to treat global IBS symptoms. Additional statements and information regarding diagnostic strategies, specific drugs, doses, and duration of therapy can be found in the guideline. SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/B755. Am J Gastroenterol 2021;116:17–44. https://doi.org/10.14309/ajg.0000000000001036; published online December 14, 2020 INTRODUCTION is highlighted by 1 study which reported that a majority of patients Irritable bowel syndrome (IBS) is a chronic, often debilitating, and wouldgiveup10–15 years of life expectancy for an instant cure for highly prevalent disorder of gut-brain interaction (previously called their condition and by another study which found that patients with functional gastrointestinal [GI] disorders) (1,2). In clinical practice, IBS would accept a median risk of sudden death of 1% if a hypo- IBS is characterized by symptoms of recurrent abdominal pain and thetical medication could cure their IBS symptoms (8,9). disordered defecation (1,3). The Rome IV criteria, derived by con- IBS causes a significant burden to health care systems worldwide. sensus from a multinational group of experts in the field of disorders As highlighted in a recent review article, direct medical costs at- of gut-brain interaction, can be used to diagnose IBS for both clinical tributed to IBS in the United States, excluding prescription and on and research purposes (4). Patients with IBS should report symp- over-the-counter medications, are estimated to be as high as 02/05/2021 toms of abdominal pain at least once weekly (on average) in asso- $1.5–$10 billion per year (10). High levels of health care resource ciation with a change in stool frequency, a change in stool form, and/ utilization, testing that is often unnecessary or performed too fre- or relief or worsening of abdominal pain related to defecation quently, and significant regional variation in testing and treatment (Table 1). Although bloating is a commonly reported symptom, its further contribute to substantial direct and indirect costs (11,12). presence is not mandatory to accurately diagnose IBS (4). The management of IBS has been examined in several recent IBS is a common source of referrals to gastroenterologists with a monographs, reviews, and position statements (1,3,4). These prevalence of approximately 4.4%–4.8% in the United States, publications summarize and review data and provide manage- United Kingdom, and Canada and affects most commonly women ment recommendations based on meta-analysis and/or expert and individuals younger than 50 years (5). Symptoms of IBS greatly opinion. However, essential diagnostic and treatment recom- affect patients’ quality of life (6,7), and this marked negative impact mendations have not been formally evaluated by the American 1Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA; 2Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, California, USA; 3Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA; 4Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA; 5Icahn School of Medicine at Mount Sinai, New York, New York, USA; 6Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA; 7Division of Gastroenterology and Hepatology, University of North Carolina, College of Medicine, Charlotte, North Carolina, USA. Correspondence: Brian E. Lacy, PhD, MD, FACG. E-mail: [email protected]. Received April 15, 2020; accepted October 8, 2020 © 2020 by The American College of Gastroenterology The American Journal of GASTROENTEROLOGY Copyright © 2020 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited. 18 Lacy et al. data to assess the quality of evidence and given strength of rec- Table 1. Rome IV diagnostic criteria for irritable bowel ommendation. The quality of evidence was expressed as high syndrome (4) (estimate of effect is unlikely to change with new data), moderate, ff Recurrent abdominal pain on average at least 1 d/wk in the last 3 mo, low, or very low (estimate of e ect is very uncertain). GRADE associated with 2 or more of the following criteria uses objective reproducible criteria to determine quality of evi- dence and risk of bias among relevant studies, including evidence 1. Related to defecation of publication bias, unexplained heterogeneity among studies, 2. Associated with a change in the frequency of stool directness of the evidence, and precision of the estimate of effect 3. Associated with a change in the form (appearance) of stool (13). A summary of the quality of evidence for the statements is given in Table 4. The strength of recommendation is given as These criteria should be fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis. either strong (most patients should receive the recommended Adapted with permission from Bowel Disorders. Gastroenterology 2016;150: course of action) or conditional (many patients will have this 1393–407. ©2016 AGA Institute. Published by Elsevier. All rights reserved. recommended course of action, but different choices may be appropriate for some patients). In the case of conditional rec- ommendations, a greater discussion is warranted, so that each College of Gastroenterology (ACG) using rigorous Grading of patient can arrive at a decision based on their values and pref- Recommendations, Assessment, Development, and Evaluation erences. The strength of recommendation is based on the quality (GRADE) methodology. This ACG clinical guideline was de- of evidence and risks vs benefits (14). veloped to provide clinicians with high quality evidence, when Weused a modified Delphi approach to achieve consensus. Each available, to support essential clinical questions relevant to the statement was presented during a monthly phone conference and diagnosis and management of IBS (Table 2). voted on by all expert authors. Statements were revised and then either presented again on a phone conference or circulated by email. SCOPE OF THE GUIDELINE AND METHODOLOGY One face-to-face meeting was held. The vote on the final recom- This guideline will focus on key issues related to the diagnosis and mendation and quality of evidence for each statement was unani- management of IBS. Given the complexity of IBS, it is not possible mous. A summary of the recommendations is given in Table 2. to address all diagnostic and management issues. Clinically rel- evant questions were developed by a panel of experts who focus Recommendation their clinical and research efforts on disorders of gut-brain in- teraction (previously called functional GI disorders). The group We recommend that serologic testing be performed to rule out formulated 25 key statements that followed the population, in- celiac disease (CD) in patients with IBS and diarrhea symptoms. tervention, comparator, and outcome format to guide the search Strong recommendation; moderate quality of evidence. for evidence (Table 3). These questions were answered by per- forming a comprehensive international literature search (see CD is an immune-mediated disease in which foods containing methods below). This guideline focuses primarily on the evalu- the storage protein gluten lead to enteropathy in genetically
Load more

Recommended publications
  • Gastrointestinal (GI) Motility, Chronic Therapeutic Class Review
    Gastrointestinal (GI) Motility, Chronic Therapeutic Class Review (TCR) March 7, 2019 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, digital scanning, or via any information storage or retrieval system without the express written consent of Magellan Rx Management. All requests for permission should be mailed to: Magellan Rx Management Attention: Legal Department 6950 Columbia Gateway Drive Columbia, Maryland 21046 The materials contained herein represent the opinions of the collective authors and editors and should not be construed to be the official representation of any professional organization or group, any state Pharmacy and Therapeutics committee, any state Medicaid Agency, or any other clinical committee. This material is not intended to be relied upon as medical advice for specific medical cases and nothing contained herein should be relied upon by any patient, medical professional or layperson seeking information about a specific course of treatment for a specific medical condition. All readers of this material are responsible for independently obtaining medical advice and guidance from their own physician and/or other medical professional in regard to the best course of treatment for their specific medical condition. This publication, inclusive of all forms contained herein, is intended to be educational in nature and is intended to be used for informational purposes only. Send comments and suggestions to [email protected]. March 2019 Proprietary Information. Restricted Access – Do not disseminate or copy without approval. © 2004–2019 Magellan Rx Management. All Rights Reserved. FDA-APPROVED INDICATIONS Drug Manufacturer Indication(s) alosetron (Lotronex®)1 generic, .
    [Show full text]
  • The National Drugs List
    ^ ^ ^ ^ ^[ ^ The National Drugs List Of Syrian Arab Republic Sexth Edition 2006 ! " # "$ % &'() " # * +$, -. / & 0 /+12 3 4" 5 "$ . "$ 67"5,) 0 " /! !2 4? @ % 88 9 3: " # "$ ;+<=2 – G# H H2 I) – 6( – 65 : A B C "5 : , D )* . J!* HK"3 H"$ T ) 4 B K<) +$ LMA N O 3 4P<B &Q / RS ) H< C4VH /430 / 1988 V W* < C A GQ ") 4V / 1000 / C4VH /820 / 2001 V XX K<# C ,V /500 / 1992 V "!X V /946 / 2004 V Z < C V /914 / 2003 V ) < ] +$, [2 / ,) @# @ S%Q2 J"= [ &<\ @ +$ LMA 1 O \ . S X '( ^ & M_ `AB @ &' 3 4" + @ V= 4 )\ " : N " # "$ 6 ) G" 3Q + a C G /<"B d3: C K7 e , fM 4 Q b"$ " < $\ c"7: 5) G . HHH3Q J # Hg ' V"h 6< G* H5 !" # $%" & $' ,* ( )* + 2 ا اوا ادو +% 5 j 2 i1 6 B J' 6<X " 6"[ i2 "$ "< * i3 10 6 i4 11 6! ^ i5 13 6<X "!# * i6 15 7 G!, 6 - k 24"$d dl ?K V *4V h 63[46 ' i8 19 Adl 20 "( 2 i9 20 G Q) 6 i10 20 a 6 m[, 6 i11 21 ?K V $n i12 21 "% * i13 23 b+ 6 i14 23 oe C * i15 24 !, 2 6\ i16 25 C V pq * i17 26 ( S 6) 1, ++ &"r i19 3 +% 27 G 6 ""% i19 28 ^ Ks 2 i20 31 % Ks 2 i21 32 s * i22 35 " " * i23 37 "$ * i24 38 6" i25 39 V t h Gu* v!* 2 i26 39 ( 2 i27 40 B w< Ks 2 i28 40 d C &"r i29 42 "' 6 i30 42 " * i31 42 ":< * i32 5 ./ 0" -33 4 : ANAESTHETICS $ 1 2 -1 :GENERAL ANAESTHETICS AND OXYGEN 4 $1 2 2- ATRACURIUM BESYLATE DROPERIDOL ETHER FENTANYL HALOTHANE ISOFLURANE KETAMINE HCL NITROUS OXIDE OXYGEN PROPOFOL REMIFENTANIL SEVOFLURANE SUFENTANIL THIOPENTAL :LOCAL ANAESTHETICS !67$1 2 -5 AMYLEINE HCL=AMYLOCAINE ARTICAINE BENZOCAINE BUPIVACAINE CINCHOCAINE LIDOCAINE MEPIVACAINE OXETHAZAINE PRAMOXINE PRILOCAINE PREOPERATIVE MEDICATION & SEDATION FOR 9*: ;< " 2 -8 : : SHORT -TERM PROCEDURES ATROPINE DIAZEPAM INJ.
    [Show full text]
  • Norfolk & Waveney Prescriber
    The Norfolk & Waveney Prescriber Issue 119 April 2017 For Primary and Secondary Care Health Professionals in Norfolk & Waveney In this issue: Prescribing Safety News: MHRA Drug Safety Updates 2 TAG and Commissioning News 3-4 Drugs – discontinued, shortages and prices 5-6 Drugs – supply issues 7-8 Guidance and Policy News: - National: “NICE Bites” & NICE guidance 9-10 Guidance and Policy News: - Local: Key Message Bulletins 11-12 Cost-effective Prescribing Tips: 13 Ophthalmic Special Order products Atorvastatin Hot Topic: Multimorbidity and Polypharmacy 14 Prescribing Safety: Medicines and Serotonin Syndrome 15-16 Prescribing Advice: Metformin, Finasteride, and Inhalers 17-18 New Medicines & Indications News 19 Feedback and comments on this edition to [email protected] / 01603 257035 Prescribing & Medicines Management Team – 1 NEL CSU Anglia Prescribing Safety News Main points from MHRA Drug Safety Updates February - March 2017 Articles relevant to Primary Care and Secondary Care: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes) Canagliflozin may increase the risk of lower-limb amputation (mainly toes) in patients with type 2 diabetes. Evidence does not show an increased risk for dapagliflozin and empagliflozin, but the risk may be a class effect. Preventive foot care is important for all patients with diabetes. Advice for healthcare professionals: o carefully monitor patients receiving canagliflozin who have risk factors for amputation, such as poor control of diabetes and problems with
    [Show full text]
  • Fecal Microbiota Transplant from Human to Mice Gives Insights Into the Role of the Gut Microbiota in Non-Alcoholic Fatty Liver Disease (NAFLD)
    microorganisms Article Fecal Microbiota Transplant from Human to Mice Gives Insights into the Role of the Gut Microbiota in Non-Alcoholic Fatty Liver Disease (NAFLD) Sebastian D. Burz 1,2 , Magali Monnoye 1, Catherine Philippe 1, William Farin 3 , Vlad Ratziu 4, Francesco Strozzi 3, Jean-Michel Paillarse 3, Laurent Chêne 3, Hervé M. Blottière 1,2 and Philippe Gérard 1,* 1 Micalis Institute, Université Paris-Saclay, INRAE, AgroParisTech, 78350 Jouy-en-Josas, France; [email protected] (S.D.B.); [email protected] (M.M.); [email protected] (C.P.); [email protected] (H.M.B.) 2 Université Paris-Saclay, INRAE, MetaGenoPolis, 78350 Jouy-en-Josas, France 3 Enterome, 75011 Paris, France; [email protected] (W.F.); [email protected] (F.S.); [email protected] (J.-M.P.); [email protected] (L.C.) 4 INSERM UMRS 1138, Centre de Recherche des Cordeliers, Hôpital Pitié-Salpêtrière, Sorbonne-Université, 75006 Paris, France; [email protected] * Correspondence: [email protected]; Tel.: +33-134652428 Abstract: Non-alcoholic fatty liver diseases (NAFLD) are associated with changes in the composition and metabolic activities of the gut microbiota. However, the causal role played by the gut microbiota in individual susceptibility to NAFLD and particularly at its early stage is still unclear. In this context, we transplanted the microbiota from a patient with fatty liver (NAFL) and from a healthy individual to two groups of mice. We first showed that the microbiota composition in recipient mice Citation: Burz, S.D.; Monnoye, M.; resembled the microbiota composition of their respective human donor. Following administration Philippe, C.; Farin, W.; Ratziu, V.; Strozzi, F.; Paillarse, J.-M.; Chêne, L.; of a high-fructose, high-fat diet, mice that received the human NAFL microbiota (NAFLR) gained Blottière, H.M.; Gérard, P.
    [Show full text]
  • Muscarinic Acetylcholine Receptor
    mAChR Muscarinic acetylcholine receptor mAChRs (muscarinic acetylcholine receptors) are acetylcholine receptors that form G protein-receptor complexes in the cell membranes of certainneurons and other cells. They play several roles, including acting as the main end-receptor stimulated by acetylcholine released from postganglionic fibersin the parasympathetic nervous system. mAChRs are named as such because they are more sensitive to muscarine than to nicotine. Their counterparts are nicotinic acetylcholine receptors (nAChRs), receptor ion channels that are also important in the autonomic nervous system. Many drugs and other substances (for example pilocarpineand scopolamine) manipulate these two distinct receptors by acting as selective agonists or antagonists. Acetylcholine (ACh) is a neurotransmitter found extensively in the brain and the autonomic ganglia. www.MedChemExpress.com 1 mAChR Inhibitors & Modulators (+)-Cevimeline hydrochloride hemihydrate (-)-Cevimeline hydrochloride hemihydrate Cat. No.: HY-76772A Cat. No.: HY-76772B Bioactivity: Cevimeline hydrochloride hemihydrate, a novel muscarinic Bioactivity: Cevimeline hydrochloride hemihydrate, a novel muscarinic receptor agonist, is a candidate therapeutic drug for receptor agonist, is a candidate therapeutic drug for xerostomia in Sjogren's syndrome. IC50 value: Target: mAChR xerostomia in Sjogren's syndrome. IC50 value: Target: mAChR The general pharmacol. properties of this drug on the The general pharmacol. properties of this drug on the gastrointestinal, urinary, and reproductive systems and other… gastrointestinal, urinary, and reproductive systems and other… Purity: >98% Purity: >98% Clinical Data: No Development Reported Clinical Data: No Development Reported Size: 10mM x 1mL in DMSO, Size: 10mM x 1mL in DMSO, 1 mg, 5 mg 1 mg, 5 mg AC260584 Aclidinium Bromide Cat. No.: HY-100336 (LAS 34273; LAS-W 330) Cat.
    [Show full text]
  • Reference List of Drugs with Potential Anticholinergic Effects 1, 2, 3, 4, 5
    ANTICHOLINERGICS: Reference List of Drugs with Potential Anticholinergic Effects 1, 2, 3, 4, 5 J Bareham BSP © www.RxFiles.ca Aug 2021 WHENEVER POSSIBLE, AVOID DRUGS WITH MODERATE TO HIGH ANTICHOLINERGIC ACTIVITY IN OLDER ADULTS (>65 YEARS OF AGE) Low Anticholinergic Activity; Moderate/High Anticholinergic Activity -B in combo Beers Antibiotics Antiparkinsonian Cardiovascular Agents Immunosuppressants ampicillin *ALL AVAILABLE AS amantadine SYMMETREL atenolol TENORMIN azaTHIOprine IMURAN cefOXitin GENERIC benztropine mesylate COGENTIN captopril CAPOTEN cyclosporine NEORAL clindamycin bromocriptine PARLODEL chlorthalidone GENERIC ONLY hydrocortisone CORTEF gentamicin (Oint & Sol’n NIHB covered) carbidopa/levodopa SINEMET digoxin LANOXIN, TOLOXIN methylprednisolone MEDROL piperacillin entacapone COMTAN dilTIAZem CARDIZEM, TIAZAC prednisone WINPRED dipyridamole PERSANTINE, ethopropazine PARSITAN vancomycin phenelzine NARDIL AGGRENOX disopyramide RYTHMODAN Muscle Relaxants pramipexole MIRAPEX Antidepressants baclofen LIORESAL ( on intrathecal only) procyclidine KEMADRIN furosemide LASIX amitriptyline ELAVIL cyclobenzaprine FLEXERIL selegiline ELDEPRYL hydrALAZINE APRESOLINE clomiPRAMINE ANAFRANIL isosorbide ISORDIL methocarbamol ROBAXIN OTC trihexyphenidyl ARTANE desipramine NORPRAMIN metoprolol LOPRESOR orphenadrine NORFLEX OTC doxepin >6mg SINEQUAN Antipsychotics NIFEdipine ADALAT tiZANidine ZANAFLEX A imipramine TOFRANIL quiNIDine GENERIC ONLY C ARIPiprazole ABILIFY & MAINTENA
    [Show full text]
  • Pharmacy and Poisons (Third and Fourth Schedule Amendment) Order 2017
    Q UO N T FA R U T A F E BERMUDA PHARMACY AND POISONS (THIRD AND FOURTH SCHEDULE AMENDMENT) ORDER 2017 BR 111 / 2017 The Minister responsible for health, in exercise of the power conferred by section 48A(1) of the Pharmacy and Poisons Act 1979, makes the following Order: Citation 1 This Order may be cited as the Pharmacy and Poisons (Third and Fourth Schedule Amendment) Order 2017. Repeals and replaces the Third and Fourth Schedule of the Pharmacy and Poisons Act 1979 2 The Third and Fourth Schedules to the Pharmacy and Poisons Act 1979 are repealed and replaced with— “THIRD SCHEDULE (Sections 25(6); 27(1))) DRUGS OBTAINABLE ONLY ON PRESCRIPTION EXCEPT WHERE SPECIFIED IN THE FOURTH SCHEDULE (PART I AND PART II) Note: The following annotations used in this Schedule have the following meanings: md (maximum dose) i.e. the maximum quantity of the substance contained in the amount of a medicinal product which is recommended to be taken or administered at any one time. 1 PHARMACY AND POISONS (THIRD AND FOURTH SCHEDULE AMENDMENT) ORDER 2017 mdd (maximum daily dose) i.e. the maximum quantity of the substance that is contained in the amount of a medicinal product which is recommended to be taken or administered in any period of 24 hours. mg milligram ms (maximum strength) i.e. either or, if so specified, both of the following: (a) the maximum quantity of the substance by weight or volume that is contained in the dosage unit of a medicinal product; or (b) the maximum percentage of the substance contained in a medicinal product calculated in terms of w/w, w/v, v/w, or v/v, as appropriate.
    [Show full text]
  • Effect of Diazepam and Hyoscine Butylbromide on Response to Secretin and Cholecystokinin-Pancreozymin in Man
    Gut: first published as 10.1136/gut.17.5.351 on 1 May 1976. Downloaded from Gut, 1976, 17, 351-353 Effect of diazepam and hyoscine butylbromide on response to secretin and cholecystokinin-pancreozymin in man J. H. B. SAUNDERS, GUYA MASOERO, AND K. G. WORMSLEY' From the Department of Therapeutics, University of Dundee, Dundee SUMMARY Ten subjects received secretin and cholecystokinin or, in duplicate tests, the two hor- mones together with either diazepam or diazepam plus hyoscine butylbromide in order to determine whether these drugs, which are often used during retrograde endoscopic cannulation ofthe pancreatic duct, affect pancreatic and biliary secretion in response to the hormones. Diazepam with hyoscine butylbromide reduced the secretion of trypsin into the duodenum and delayed the appearance of both trypsin and bilirubin in duodenal aspirate. These effects must be taken into account when interpreting pancreatic and biliary responses measured during direct cannulation of the pancreatic duct. Endoscopic retrograde cannulation of the pancreatic vents in the antrum. Secretin (1 clinical unit/kg-h) duct has recently been used to measure pancreatic and cholecystokinin-pancreozymin (1 Ivy unit/ function by collecting the pancreatic juice directly kg-h) were administered for 45 minutes by continuous from the pancreatic duct during stimulation with intravenous infusion in 0 15 mol/1 sodium chloride. hormones et The exogenous (Cotton al., 1974; Gregg hormones had been purchased from the GIH http://gut.bmj.com/ et al., 1975; Robberecht et
    [Show full text]
  • 1: Gastro-Intestinal System
    1 1: GASTRO-INTESTINAL SYSTEM Antacids .......................................................... 1 Stimulant laxatives ...................................46 Compound alginate products .................. 3 Docuate sodium .......................................49 Simeticone ................................................... 4 Lactulose ....................................................50 Antimuscarinics .......................................... 5 Macrogols (polyethylene glycols) ..........51 Glycopyrronium .......................................13 Magnesium salts ........................................53 Hyoscine butylbromide ...........................16 Rectal products for constipation ..........55 Hyoscine hydrobromide .........................19 Products for haemorrhoids .................56 Propantheline ............................................21 Pancreatin ...................................................58 Orphenadrine ...........................................23 Prokinetics ..................................................24 Quick Clinical Guides: H2-receptor antagonists .......................27 Death rattle (noisy rattling breathing) 12 Proton pump inhibitors ........................30 Opioid-induced constipation .................42 Loperamide ................................................35 Bowel management in paraplegia Laxatives ......................................................38 and tetraplegia .....................................44 Ispaghula (Psyllium husk) ........................45 ANTACIDS Indications:
    [Show full text]
  • COMPARISON of the WHO ATC CLASSIFICATION & Ephmra/Intellus Worldwide ANATOMICAL CLASSIFICATION
    COMPARISON OF THE WHO ATC CLASSIFICATION & EphMRA/Intellus Worldwide ANATOMICAL CLASSIFICATION: VERSION June 2019 2 Comparison of the WHO ATC Classification and EphMRA / Intellus Worldwide Anatomical Classification The following booklet is designed to improve the understanding of the two classification systems. The development of the two systems had previously taken place separately. EphMRA and WHO are now working together to ensure that there is a convergence of the 2 systems rather than a divergence. In order to better understand the two classification systems, we should pay attention to the way in which substances/products are classified. WHO mainly classifies substances according to the therapeutic or pharmaceutical aspects and in one class only (particular formulations or strengths can be given separate codes, e.g. clonidine in C02A as antihypertensive agent, N02C as anti-migraine product and S01E as ophthalmic product). EphMRA classifies products, mainly according to their indications and use. Therefore, it is possible to find the same compound in several classes, depending on the product, e.g., NAPROXEN tablets can be classified in M1A (antirheumatic), N2B (analgesic) and G2C if indicated for gynaecological conditions only. The purposes of classification are also different: The main purpose of the WHO classification is for international drug utilisation research and for adverse drug reaction monitoring. This classification is recommended by the WHO for use in international drug utilisation research. The EphMRA/Intellus Worldwide classification has a primary objective to satisfy the marketing needs of the pharmaceutical companies. Therefore, a direct comparison is sometimes difficult due to the different nature and purpose of the two systems.
    [Show full text]
  • Guts and Butts: Treatment Options for IBS and Functional Dyspepsia
    7/2/2020 Guts and Butts: Treatment Options for IBS and Functional Dyspepsia Amy McCracken, DNP, APRN 1 Learning Objectives: ● Discuss the diagnosis and management of IBS and functional dyspepsia in order to optimize treatment strategies ● Describe pharmacological and alternative treatment approaches of IBS-C, IBS-D, IBS-M, and functional dyspepsia ● Articulate patient-specific treatment options for those with IBS and functional dyspepsia as derived from case studies 2 1 7/2/2020 Irritable Bowel Syndrome (IBS)-Definition and Epidemiology ● Comprises a group of functional bowel disorders in which abdominal discomfort or pain is associated with defecation or a change in bowel habits in the absence of an organic disease. ● The prevalence of IBS in North America is estimated at approximately 10-15%. ● More common in women compared to men. ● Second highest cause of work absenteeism ● IBS accounts for approximately 25 to 50% of all referrals to gastroenterologists. ● Important to remember: This is a diagnosis of exclusion! 3 IBS-Etiology ● Stress ● Visceral hypersensitivity ● Psychosocial factors ● Common-cannot be explained ● Chronic and benign ● High association with stress in the pathophysiology and clinical presentation of IBS 4 2 7/2/2020 IBS-Signs and Symptoms ● Chronic abdominal pain-usually a cramping sensation that varies in intensity with periodic exacerbations ● The character and location of pain can vary widely and often times related to defecation ● Abdominal fullness, bloating or swelling ● Diarrhea, constipation or alternating
    [Show full text]
  • New Treatment Options for Chronic Constipation: Mechanisms, Efficacy and Safety
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE CHRONIC CONSTIPATION – CHALLENGES AND REMEDIES provided by Crossref New treatment options for chronic constipation: Mechanisms, efficacy and safety Michael Camilleri MD M Camilleri. New treatment options for chronic constipation: De nouvelles options thérapeutiques contre la Mechanisms, efficacy and safety. Can J Gastroenterol constipation chronique : leurs mécanismes, leur 2011;(Suppl B):29B-35B. efficacité et leur innocuité The present review has several objectives, the first of which is to review the pharmacology and selectivity of serotonergic agents to La présente analyse comporte plusieurs objectifs, le premier étant de contrast the older serotonergic agents (which were withdrawn because réviser la pharmacologie et la sélectivité des sérotoninergiques pour of cardiac or vascular adverse effects) with the newer generation sero- comparer les anciens sérotoninergiques (retirés du marché en raison de tonin receptor subtype 4 agonists. Second, the chloride ion secret- leurs effets cardiaques ou vasculaires) avec les agonistes de récepteurs agogues that act through the guanylate cyclase C receptor are appraised de la sérotonine de sous-type 4 de nouvelle génération. En deuxième and their pharmacology is compared with the approved medication, lieu, les sécrétagogues des ions chlorures qui agissent par le récepteur lubiprostone. Third, the efficacy and safety of the application of bile du guanylatecyclase C sont évalués, et leur pharmacologie est com- acid modulation to treat constipation are addressed. The long-term parée avec celle du lubiprostone, un médicament approuvé. En studies of surgically induced excess bile acid delivery to the colon are troisième lieu, l’efficacité et l’innocuité de l’application de la modula- reviewed to ascertain the safety of this therapeutic approach.
    [Show full text]